by Jeff Siegel
woman thinkingAny condition described by the word "syndrome" can sound alarming.
But premenopausal syndrome is nothing to fear; it's a perfectly normal phase of
a woman's life signifying the beginning of menopause. The syndrome can cause hot
flashes, night sweats and consistently inconsistent menstruation, and may occur
several years before menopause actually occurs. Overall, it's entirely natural,
rarely fatal, and certainly not a disease, which is implied by calling it a
syndrome.
"There are much better things to call it than a syndrome," says Ann M. Voda,
R.N., Ph.D., the immediate past president of the North American Menopause
Society and a professor at the University of Utah College of Nursing in Salt
Lake City. "Women get confused when they hear that, because they think it's
something that needs to be cured. It's not. It's all part of the transition in a
woman as she gets older."
Changes: physical and emotional Menopause itself is defined as the cessation of
the menstrual cycle for 12 months, and it usually occurs around age 50. The
entire process -- measured from the first hot flash through to the end of the
12th month after the last menstrual period -- is called the climacteric. The
period leading up to menopause, called perimenopause in medical textbooks, can
take up to eight years, and occurs when estrogen levels begin to drop.
Perimenopause brings with it a host of well-known side effects, including
irregular periods, hot flashes, vaginal dryness, an increase in facial hair,
sleeplessness, paranoia, and irritability.
In addition, women going through the menopausal years seem to be more at risk
from conditions such as osteoporosis and various forms of heart disease. Doctors
are also beginning to suspect a link between Alzheimer's disease (more prevalent
in women than in men), and the changes that the body undergoes during menopause.
And if all this weren't enough, the onset of menopause comes at a time in many
women's lives when they already have enough to worry about -- elderly parents
who may need special care, children leaving home (or not, as the case may be), a
marriage or relationship that is approaching a critical stage, and a job that
may be making increasing demands. Who needs to go through a rite of passage that
many regard as the beginning of old age when they have all this other
aggravation?
In an attempt to treat the side effects and to deal with the links between
menopause and its physical and emotional symptoms, health care professionals
came up with the term "premenopausal syndrome."
"Whatever you call it, the most important thing to realize is that it just
doesn't happen -- that it just doesn't take place on a Tuesday and then it's
over with," says Robert K. Zurawin, M.D., an assistant professor of obstetrics
and gynecology at Baylor University College of Medicine in Houston. "You have to
consider the entire spectrum of events, and that it can take place over many
years."
The first menopausal effects occur when the ovaries stop producing eggs, a
process that is as natural a part of aging as gray hair and wrinkles. This
failure to produce eggs, say doctors, triggers menopause's side effects. These
effects can be traced to a lack of estrogen and progesterone. Without eggs, the
body doesn't produce enough of these two crucial hormones.
Estrogen treatment and its effects That's why most doctors treat the effects of
menopause with estrogen replacement therapy (which often includes progesterone),
in the form of pills or a patch. This is, however, a course that has elicited a
number of concerns, with a fair amount of tussling between the pro- and
anti-estrogen camps. Their debate is centered around a possible relationship
between breast cancer and higher levels of estrogen in menopausal women.(For
more information on hormone replacement therapy, link to HealthGate's article
here.)
"We won't know for sure if there is a link for about 10 years, when the
randomized trials that are just starting are complete," says Susan R. Johnson,
M.D., a gynecologist who is associate dean at the University of Iowa College of
Medicine in Iowa City. "What we do know, from my point of view anyway, is that
the approach that estrogen is all right in all cases is just as dangerous as the
approach that it should never be used. Right now, we just don't know all of the
answers."
What doctors do know -- and agree on -- is that women who are going through the
menopausal years should keep a number of factors in mind in considering estrogen
therapy:
- How bad is bad? Taking estrogen to relieve severe hot flashes, night sweats and the like is one thing. But as many as three-quarters of menopausal women, says Dr. Johnson, don't experience severe side effects. In their case, taking estrogen to relieve a little discomfort may be too much of a good thing. In fact, she says, it might not be a bad idea to wait until well past the menopausal years -- as late as age 60 or 70 -- to get the most benefit from estrogen in preventing osteoporosis and heart disease.
- Risks vs. benefits. On one hand, says Dr. Zurawin, estrogen therapy is known to decrease a woman's chances of suffering from heart disease and osteoporosis. Also, estrogen has not been linked to uterine, cervical, and ovarian cancers. On the other hand, the possible link between estrogen and breast cancer has not yet been substantiated. "I just think, given the benefits, it's worth the risks, and that's what I tell my patients," he explains.
- Family history. Women whose mother or sister developed breast cancer at an early age must pay more attention to possible estrogen links than women without a family history of breast cancer, or who had a close female relative develop the cancer late in life.
- Maintaining equilibrium. Given the possible emotional tangles from family and job at this point in a woman's life, "it's important to keep an eye on your emotional well-being," says Dr. Zurawin. "There's an underlying stress from your life, and there's a stress from the menopause. That's often a difficult combination."
woman at doctors appointmentEstrogen is not the only possibility for dealing
with the repercussions of menopause, although even its most ardent foes agree
that it's the most efficient method. Indications are that calcium supplements
may help prevent osteoporosis, while vitamins may mitigate some of the physical
side effects. Based on the experiences of Asian women and vegetarians, there is
evidence showing that a healthy intake of soy may also help relieve the
symptoms. And don't underestimate the value of exercise, say doctors -- even
exercise that's as simple as a 20-minute walk three times a week. Aside from its
physical benefits, exercise is also an excellent form of stress relief.
Equally important, a woman must maintain perspective in the face of all these
changes. It's not a far stretch to say that menopause is as normal for women of
50 as puberty is for teenagers," says Dr. Johnson. "Just like puberty, it isn't
to be feared. It's just a normal biological process."